Opinion

Income should not be obstacle to good health

Hey there, time traveller! This article was published 1/10/2015 (1710 days ago), so information in it may no longer be current.

I began medical school optimistic about what becoming a physician meant I could do for my future patients. Naively, I presumed my career would involve treating patients' illnesses so they could return to lead full and fulfilling lives. Yet for the one in seven Canadians living in poverty, it is often difficult for doctors to achieve this goal.

Take Christina, a 64-year-old woman with diabetes, who came to me with new-onset numbness in her fingers and toes (a serious and progressive consequence of poorly controlled diabetes). As she struggled to leave on her walker, her prescription fell out of her purse. When I retrieved it for her, she mentioned it hardly mattered because she would not have enough money to purchase the medication anyway.

Then there was Andrew, a 36-year-old who had been physically assaulted while panhandling. He had a prosthetic hip from a work accident that left him with a pronounced limp, a chronic disability and no job. While I could screen Andrew for fractures and neurologic deficits, I could do nothing for his unemployment or his inability to find safe shelter at night.

These are but two of many encounters I have had that starkly contrast the values of social medicine I have learned in medical school. What good is it to treat illness if we can only send our patients back to the conditions that helped make them sick to begin with?

Health care is just a small part of what determines our well-being. Our health is strongly influenced by factors such as income, working environment and affordable housing -- over which neither patients nor medical doctors have much control. This is why Canada needs better public policy that safeguards the global health of all Canadians.

As residents of the ninth-richest country in the world, we have managed to ignore the erosion of social assistance and the rise in income inequality that has taken place over the recent decades. While Canada is one of the countries consistently spending the most on health care, it doesn't do a very good job of providing a social safety net for the growing numbers of Canadians living paycheque to paycheque or are under- or unemployed. It is also one of the few Organization for Economic Co-operation and Development countries without a national housing and homelessness strategy, which the United Nations committee on economic, social and cultural rights considers a "national emergency."

For a nation that once prided itself on being ranked "the best country in which to live," it has a lot to do before warranting the title once again.

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It does not have to be this way. Public-policy decisions, including those that determine the allocation of tax revenue, strongly influence health outcomes. These decisions need to be critically re-examined, particularly when most Canadians have demonstrated their support for policies that improve conditions for the most vulnerable.

In 2009, a Nanos research poll reported most Canadians strongly supported the public health system and strengthening publicly funded health care. In 2014, a poll by the Broadbent Institute found 77 per cent of Canadians recognized the widening income gap as a serious issue for the country, while 71 per cent believed this gap undermines Canadian values. The same poll found most Canadians were in favour of increasing taxes to fund public programs that will reduce the impact of income inequality.

This means Canadians are far ahead of their governments in supporting solutions to close the gap between the rich and poor and, often at the same time, the healthy and unhealthy.

Canada's current public policies could better meet both the health needs and social values of its citizens. As a soon-to-be physician, I hope to practise medicine in a nation where income is not an obstacle to good health and where policies and legislation are accountable to Canadians' priority of health for all.

Vivian Tam is a second-year medical student at McMaster University in Hamilton. She wrote this in participation with EvidenceNetwork.ca.

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